EXAMINING THE EFFECTS OF PROFESSIONAL NON-NURSING STAFFING ON QUALITY OF CARE IN NURSING HOMES

摘要

Minimum staffing regulations exist for nursing staff but staffing mandates for Physical Therapists (PT) and Occupational Therapists (OT) have yet to be established. Services from PT/OT staffing are covered by Medicare for short-stay residents requiring skilled care, but are not covered by Medicaid for long-stay, chronic care residents. This study examines the relationship between PT/OT staffing and quality to strengthen minimum staffing policies and to determine the appropriateness of these services for long-stay residents. Data from over 12,000 nursing homes were linked across the NHC, OSCAR/CASPER, LTCFocus, and AHRF datasets. The sample consists of over 43,000 nursing home observations from 2013 to 2016. Random effects and first-difference methods were used to investigate the PT/OT staffing effects on the long-stay ADLs and falls measures and the 5-star measure. The framework from the Resource Based View of the Firm theory guided the analyses. Overall, a positive relationship between PT/OT staffing and quality was found as increases to PT/OT staffing were significantly linked to improved performance in each of the three quality domains. The increases in staffing were not directly related to quality improvements. After stratifying the sample based on staffing levels, threshold effects were detected, demonstrating a non-linear association. The evidence suggest PT/OT staffing may be an important component in improving long-stay resident outcomes and overall quality. The findings lend support for minimum staffing requirements for PT/OT staffing and expanding coverage of these services under Medicaid. Interdisciplinary approaches are recommended to examine the relationship from a reimbursement or cost structure perspective.